GPs wary of rise in home births

DoH moves to encourage home births are raising concerns about patient safety.

The DoH plans to encourage a dramatic increase in home births, according to widespread speculation.

Despite official denials, DoH sources reported in the media have outlined plans to move away from the traditional assumption that hospitals are the best setting for childbirth and actively encourage pregnant women to opt for the home.

While this is unlikely to bring the UK back to 1960s levels of one in three births in the home, if enacted it is likely to result in a major rise compared to current levels of one in 50.

GPs have expressed concern about the move. They fear short-staffed midwifery services will be unable to cope with a significant increase in home births, and that GP out-of-hours services may be called out as back-up.

The Royal College of Midwives warned this month that midwifery services were reaching a 'crisis situation', because services were understaffed.

GPC member Dr Fay Wilson said: 'At some times of day and in some areas, midwifery services will not have enough practitioners to respond.'

If GPs are called out, Dr Wilson believes, many will resist taking part in home births because 'we live in a litigious age'.

Wessex LMCs chief executive Dr Nigel Watson also believes that GPs will be reluctant to assist with home births, mainly because they no longer have the skills required.

'Many GPs will be useless. It has been taken over by the midwives, and GPs have effectively been deskilled clinically. The last birth I was involved in was 15 years ago,' he said.

GP experience

By contrast, Lancashire GP Dr Anita Sharma is involved in one or two home deliveries a year, by her own choice.

But the Oldham GP agrees her case is rare: 'Across the board, there are not enough GPs with the experience of dealing with home births, even if the resources are there.'

She is concerned that encouraging home births in this way could jeopardise relationships with patients.

'If the government says anyone can have a home birth if they want it, that puts across the wrong message. Some people are not suitable,' she said.

Dr Sharma said that if GPs advised women not to have a home birth on clinical grounds, patients might believe their GP was denying them something the DoH had promised them. GPs also say patient safety could suffer if home births are increased without proper supporting infrastructure.

Dr Kathryn Newell, a GP in Oundle, Northamptonshire, and Medical Women's Federation spokeswoman, said patient safety was 'paramount'. She expressed concern that an increase in home births was being considered when maternity services were at risk.

Dr Newell said that the DoH needed to improve emergency care and possibly bring back local 'flying squads' of obstetric experts, which have been disbanded in recent years.

'The priority must be the safety of mother and child. This must be supported by appropriate emergency services,' she said.

Other GPs echoed this view.

Oxford GP Dr Tom Finnegan said: 'I agree in principle, but without training and resources, problems could arise.'

RCGP chairman Dr Mayur Lakhani added: 'GPs would be concerned if more home births were introduced in an unstructured, unsupported way.'

Dr Watson fears the move could signal even less cash for maternity services, rather than extra funding.

'Lots of small maternity units are not viable and there is talk that some will have to close. Perhaps that is why the DoH is so keen on home births,' he said.

- Midwifery services could not cope with a major increase in the number
of home births.
- Emergency cover limited because obstetric 'flying squads' have been
phased out.
- Out-of-hours GPs may be forced to cover.
- Doctor/patient relationship could be undermined.
- Patient safety could be put at risk.


Dr Anita Sharma, Chadderton South Health Centre, Oldham

'The midwife team attached to our surgery is already stretched. We just don't have the resources to do this. If it were to happen, there would need to be more money coming in.'

GPC member Dr Fay Wilson

'Health secretary Patricia Hewitt wants to see more home births, but at the same time, the government is systematically dismantling the services that would support and help people to do this.'

Birmingham LMC joint executive secretary Dr Robert Morley

'I suspect there is a hidden agenda with more consideration given to money, because care outside of hospitals is often seen as the cheaper option.'

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